循证护理对控制机械通气患者呼吸机相关性肺炎的影响
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摘要
目的探讨循证护理对控制机械通气患者呼吸机相关性肺炎(VAP)的影响。方法选取2016年2月～2018年1月我院收治的88例行机械通气治疗的患者,按照随机对照分组法分为观察组和对照组,每组各44例。对照组行常规护理操作,观察组进行循证护理操作。比较两组机械通气时间,有创通气时间,住院时间,VAP发生率及非计划拔管发生率。结果治疗后观察组的机械通气时间为(11.59±4.44)d,显著短于对照组的(14.22±5.24)d(P<0.05),治疗后观察组的有创通气时间为(4.17±1.64)d,显著短于对照组的(6.46±2.25)d(P<0.05),治疗后观察组的住院时间为(15.84±5.63)d,显著短于对照组的(18.87±6.19)d(P<0.05)。观察组的VAP发生率为15.91%,显著低于对照组(34.09%)(P<0.01)。观察组的非计划拔管发生率为4.55%,显著低于对照组(13.64%),差异有统计学意义(P<0.01)。结论机械通气患者采用循证护理操作,能显著降低患者VAP及非计划拔管发生率,缩短住院时间及机械通气时间,节省患者住院费用,值得临床推广应用。
Objective To investigate the effect of evidence-based nursing on ventilator-associated pneumonia(VAP in patients undergoing controlled mechanical ventilation. Methods Eighty-eight patients undergoing controlled mechanical ventilation were enrolled in our hospital from February 2016 to January 2018 were selected. According to the randomized control grouping method, they were divided into the observation group and the control group, 44 cases in each group. The control group patients underwent routine nursing operation, and the observation group patients underwent evidence-based nursing operation. The mechanical ventilation time, invasive ventilation time, hospital stay, ventilator-associated pneumonia rate and unplanned extubation rate were compared between the two groups. Results After treatment, the mechanical ventilation time of the observation group was(11.59±4.44) d, which was significantly shorter than that of the control group([14.22±5.24] d)(P<0.05). The invasive ventilation time of the observation group was(4.17±1.64) d, which was significantly shorter than that of the control group([6.46±2.25] d),(P<0.05). The hospital stay of the observation group was(15.84 ±5.63) d after treatment, which was significantly shorter than the control group([18.87±6.19] d)(P<0.05). The incidence of respiratory and related pneumonia in the observation group was 15.91%,which was significantly lower than that in the control group(34.09%)(P<0.01). The incidence of unplanned extubation in the observation group was 4.55%, which was significantly lower than that in the control group(13.64%), the difference was statistically significant(P<0.05). Conclusion Evidence-based nursing operation in patients with mechanical ventilation can significantly reduce the incidence of ventilator-associated pneumonia and unplanned extubation, shorten the length of hospital stay and mechanical ventilation time, and save patients′ hospitalization expenses. It is worthy of clinical application.
Objective To investigate the effect of evidence-based nursing on ventilator-associated pneumonia(VAP in patients undergoing controlled mechanical ventilation. Methods Eighty-eight patients undergoing controlled mechanical ventilation were enrolled in our hospital from February 2016 to January 2018 were selected. According to the randomized control grouping method, they were divided into the observation group and the control group, 44 cases in each group. The control group patients underwent routine nursing operation, and the observation group patients underwent evidence-based nursing operation. The mechanical ventilation time, invasive ventilation time, hospital stay, ventilator-associated pneumonia rate and unplanned extubation rate were compared between the two groups. Results After treatment, the mechanical ventilation time of the observation group was(11.59±4.44) d, which was significantly shorter than that of the control group([14.22±5.24] d)(P<0.05). The invasive ventilation time of the observation group was(4.17±1.64) d, which was significantly shorter than that of the control group([6.46±2.25] d),(P<0.05). The hospital stay of the observation group was(15.84 ±5.63) d after treatment, which was significantly shorter than the control group([18.87±6.19] d)(P<0.05). The incidence of respiratory and related pneumonia in the observation group was 15.91%,which was significantly lower than that in the control group(34.09%)(P<0.01). The incidence of unplanned extubation in the observation group was 4.55%, which was significantly lower than that in the control group(13.64%), the difference was statistically significant(P<0.05). Conclusion Evidence-based nursing operation in patients with mechanical ventilation can significantly reduce the incidence of ventilator-associated pneumonia and unplanned extubation, shorten the length of hospital stay and mechanical ventilation time, and save patients′ hospitalization expenses. It is worthy of clinical application.
引文
[1]张梅.气道优化护理对重症机械通气患者VAP的影响[J].实用临床医药杂志,2016,20(18):64-66.
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[11]顾焕萍.序贯性护理干预对心脏术后机械通气患者人机协调的影响分析[J].中国循证心血管医学杂志,2016,8(10):1251-1252.
[12]曹艳佩,杨晓莉,唐慧婷,等.气管插管危重患者口腔护理的循证实践[J].护理学杂志,2016,31(11):45-48.
[13]Zakharkina T,Martinloeches I,Matamoros S,et al.The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia[J].Thorax,2017,72(9):803-810.
[14]周晓静,夏繁.综合性护理干预对内科ICU机械通气患者VAP及治疗效果的影响[J].实用临床医药杂志,2016,20(14):1-3.
[15]曹淼,田永明,胡雪.循证护理在控制机械通气患者呼吸机相关性肺炎中的应用[J].实用临床医药杂志,2016,20(10):23-25.
[2]周雪松,刘英丽,贾磊,等.循证护理对神经外科长期昏迷患者呼吸机相关性肺炎的影响[J].实用临床医药杂志,2016,20(4):65-68.
[3]郑川燕,李霞,马静,等.重型颅脑损伤患者术后发生呼吸机相关性肺炎的影响因素分析[J].中国实用护理杂志, 2017,33(3):183-187.
[4]陈敬霞.多学科团队护理模式对机械通气患者VAP发生率影响的前瞻性研究[J].河北医药,2017,39(15):2381-2384.
[5]张寿珍.综合护理干预对颅脑损伤机械通气患者VAP的影响[J].实用临床医药杂志,2017,21(6):78-80.
[6]徐小菁,郭红,蔡虻,等.机械通气患者的护理现状及循证思考[J].中华现代护理杂志,2016,22(28):4021-4024.
[7]陈燕春,张丽涓,杨玲,等.ICU机械通气行CRRT治疗患者的循证护理效果[J].实用临床医药杂志,2017,21(22):35-37.
[8]孙建兰,周洪兰.循证护理干预对ICU重症颅脑外伤患者院内感染的预防效果研究[J].实用临床医药杂志,2017,21(10):10-13.
[9]曹淼,田永明,胡雪.气道分级管理在ICU机械通气患者中的应用[J].实用临床医药杂志,2016,20(2):41-43.
[10]朱荣兰,张云,崔荣霞.集束化护理管理策略在急诊科行机械通气患者中的应用体会[J].山西医药杂志,2017,46(7):844-846.
[11]顾焕萍.序贯性护理干预对心脏术后机械通气患者人机协调的影响分析[J].中国循证心血管医学杂志,2016,8(10):1251-1252.
[12]曹艳佩,杨晓莉,唐慧婷,等.气管插管危重患者口腔护理的循证实践[J].护理学杂志,2016,31(11):45-48.
[13]Zakharkina T,Martinloeches I,Matamoros S,et al.The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia[J].Thorax,2017,72(9):803-810.
[14]周晓静,夏繁.综合性护理干预对内科ICU机械通气患者VAP及治疗效果的影响[J].实用临床医药杂志,2016,20(14):1-3.
[15]曹淼,田永明,胡雪.循证护理在控制机械通气患者呼吸机相关性肺炎中的应用[J].实用临床医药杂志,2016,20(10):23-25.